Another gender data gap: Female drowning in Aotearoa, New Zealand

Introduction A gender gap is present in drowning research and prevention interventions, resulting in an inequitable focus on males. This study aimed to address the gender data gap, exploring female drowning in Aotearoa, New Zealand. Methods National data on female fatal and non-fatal drowning requiring hospitalisation between 2003 and 2019 were sourced from DrownBase, Water Safety New Zealand's drowning database. Univariate and χ 2 analyses were conducted for fatal and hospitalisation data. Crude rates were calculated and used to explore temporal trends and RR by age groups and ethnicity for fatal and non-fatal drowning. Ratios for drowning-related hospitalisations and Accident Compensation Corporation (ACC) claims to drowning deaths were also calculated. Results From 2003 to 2019, a total of 1087 female drowning fatalities and non-fatal (76.0%) drowning incidents requiring hospitalisation occurred. Linear trends indicate hospitalisations increased (y=0.0766x+1.4271; R 2 =0.4438), while fatal drowning decreased (y=-0.0101x+0.7671; R 2 =0.1011). The highest fatal (1.60) and non-fatal (8.22) drowning rates were seen among children aged 0-4 years. For every one female drowning fatality, there are 3.46 hospital admissions and 675.55 ACC claims. Discussion Female drowning represents a significant burden on the health system and the community in New Zealand. Further investment in interventions targeting females about their own risky behaviours around water (not only children in their care) is suggested, including interventions focused on hazardous conditions and alcohol consumption. Conclusion For decades, the focus of drowning prevention among adolescents and adults has been on males. However, efforts must be broadened to prevent any further increase in drowning-related incidents among females in Aotearoa, New Zealand

Changing driver behavior during floods: Testing a novel e-health intervention using implementation imagery

We tested the efficacy of a novel implementation imagery intervention (N = 460) in promoting safer intentions regarding driving into floodwater post-intervention, and at a four-week follow-up using a pre-registered randomized controlled design. Results showed that the intervention reduced intentions and subjective norms regarding driving into floodwater. The control condition also improved on intentions and subjective norms, but the changes appeared to only be maintained at the follow-up for the intervention group and the between group difference at the follow-up was not significant based on our pre-specified cutoff level for statistical significance of 0.01. Results also indicated that changes in intentions may be stronger for males than females. Further exploratory analyses indicated that the intervention showed greater effects on post-intervention intentions, subjective norms, perceived behavioral control, perceived severity, anticipated regret, barrier self-efficacy, and action planning in individuals who indicated a modest level of intention to drive into floodwater prior to the intervention

Personal, social, and environmental factors associated with lifejacket wear in adults and children: A systematic literature review

Objective: Drowning claims 7% of the global burden of injury-related deaths. Lifejackets are routinely recommended as a drowning prevention strategy; however, a review of related factors regarding lifejacket wear has not previously been investigated. Methods: This systematic review examined literature published from inception to December 2016 in English and German languages. The personal, social, and environmental factors associated with lifejacket wear among adults and children were investigated, a quantitative evaluation of the results undertaken, and gaps in the literature identified. Results: Twenty studies, with sample sizes of studies ranging between 20 and 482,331, were identified. Fifty-five percent were cross-sectional studies. All studies were scored IV or V on the Australian National Health and Medical Research Council (NHMRC) grading system indicating mostly descriptive and cross-sectional levels of evidence. Factors associated with increased wear included age (mostly children), gender (mostly female), boat type (non-motorised), boat size (small boats), role modelling (children influenced by adult lifejacket wear), and activity (water-skiing, fishing). Factors not associated or inconsistent with lifejacket wear included education, household income, ethnicity, boating ability, confidence in lifejackets, waterway type, and weather and water conditions. Factors associated with reduced lifejacket wear included adults, males, discomfort, cost and accessibility, consumption of alcohol, and swimming ability. Three studies evaluated the impact of interventions. Conclusion: This review identified factors associated with both increased and decreased lifejacket wear. Future research should address the motivational factors associated with individuals’ decisions to wear or not wear lifejackets. This, combined with further research on the evaluation of interventions designed to increase lifejacket wear, will enhance the evidence base to support future drowning prevention interventions

Latest results show urgent need to address child restraint use.

Road traffic crashes are the leading cause of morbidity and mortality in children in South Africa (SA), and are preventable through implementing a systems approach to address the causes. Proper education, child passenger legislation and enforcement of the law are priority actions. It is well known that properly employed seatbelts and child restraints reduce the risk of serious injury and death to children. However, despite campaigns such as ‘Arrive Alive’ to increase the use of child restraints, a 2008 observational study conducted by Red Cross War Memorial Children’s Hospital (RCWMH) in Cape Town, SA, found that a majority of adults and children entering the hospital gates did not use such restraints. It is possible that this was because there was no appropriate child restraint law

Drivers’ experiences during floods: Investigating the psychological influences underpinning decisions to avoid driving through floodwater

A major risk factor for many flood-related drownings is driving through floodwater. We aimed to understand Australian drivers’ experiences and beliefs with respect to avoid driving through floodwater using the theory of planned behaviour as a framework. Study 1 (N = 23) used a qualitative design to gain an in-depth understanding of individuals’ experiences with driving through floodwater. Study 2 (N = 157) used a survey-based design to identify the factors related to this behaviour including knowledge, beliefs, and social-cognitive factors. In Study 1, drivers identified a range of advantages (e.g., didn't damage car), disadvantages (e.g., inconvenient, but not so terrible), barriers (e.g., urgency to reach destination), and facilitators (e.g., making plans and using existing plans) to avoiding driving through floodwater. Normative factors were also important influences on drivers’ decisions including normative expectancy, approval of significant others, and a moral obligation for the safety of others. In Study 2, participants were able to recall information about driving through floodwater (e.g., dangerous/risky) and its meaning (e.g., body of water over road). A range of experiences were described for avoiding driving through floodwater (e.g., took an alternative route). Across the studies, a range of behavioural, normative, and control beliefs were elicited. Finally, sex (women more likely), attitude, subjective norm, and perceived behavioural control significantly predicted intentions to avoid driving through floodwater, with the model explaining 55% of the variance. These findings can inform intervention targets and development of prevention strategies for effective behaviour change, saving lives otherwise lost to Australian waterways in flood

Predictors of Depression for Low-Income African American Single Mothers

Purpose: To test a model of predictors of depression in low-income single African American mothers. Design: Secondary analysis of existing data collected as part of a study of women at risk for clinical depression. Methods: Cross sectional secondary data analysis of a study of low-income African American single mothers with children ages 2-6. Path analysis was used to test a model of the potential mediating role of negative thinking. It was hypothesized that negative thinking mediates the effects of chronic stressors, general health status, and self-esteem on depressive symptoms Finding: Negative thinking mediated the relationships of chronic stressors and self-esteem with depressive symptoms. Conclusions: These findings supported the proposed model with one exception: negative thinking did not mediate the effects of physical health on depressive symptoms. Physical health also had no direct effect on depressive symptoms. Negative thinking may play a pivotal role in the development of depression for these at risk women. Self-esteem, chronic stressors and negative thinking should be important considerations in designing interventions to improve the mental health of at-risk African American women

A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions

Aim: To collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions. Methods: We recruited adult airway clearance device users between July 1, 2021 and June 30, 2023 using a centralized website and email follow-up. The data collection tool captured patient, responder, situation, and outcome variables. Multi-step respondent validation occurred using electronic and geolocation verification, a random selection follow-up process, and physician review of all submitted cases. Results: We recruited 186 airway clearance device users (LifeVac©:157 [84.4%]; Dechoker©:29 [15.6%]). LifeVac© was the last intervention before foreign body airway obstruction relief in 151 of 157 cases. Of these, 150 survived to discharge. A basic life support intervention was used before LifeVac© in 119 cases, including the 6 cases where LifeVac© also failed. We identified two adverse events using LifeVac© (perioral bruising), while we could not ascertain whether another 7 were due to the foreign body or LifeVac© (3 = airway edema; 3 = oropharyngeal abrasions; 1 = esophageal perforation). Dechoker© was the last intervention before obstruction relief in 27 of 29 cases and all cases survived. A basic life support intervention was used before Dechoker© in 21 cases, including both where Dechoker© also failed. We identified one adverse event using Dechoker© (oropharyngeal abrasions). Conclusion: Within these cases, airway clearance devices appear to be effective at relieving foreign body airway obstructions. However, this data should be considered preliminary and hypothesis generating due to several limitations. We urge the resuscitation community to proactively evaluate airway clearance devices to ensure the public remains updated with best practices. © 2023 The Author(s)Dr. Amy Peden is funded by a National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship (Grant ID: APP2009306) which supported open access publication. No funding was obtained for the conduct of the study

A scoping review of female drowning: an underexplored issue in five high-income countries

Background: Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods: A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results: The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion: Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning

Endovascular occlusion of right to left arteriovenous shunt associated with persistent left superior vena cava

Left-sided superior vena cava (SVC) as the result of persistence of the left superior cardinal vein in postnatal life is a rare congenital anomaly, is usually associated with other cardiac defects, and can cause symptoms of right to left shunt. We report the case of a 58-year-old Asian man with a history of end-stage renal disease and Ebstein anomaly that was corrected surgically who presented with progressively worsening disabling dyspnea. An echocardiogram with concomitant intravenous saline injection raised the suspicion of right to left shunt, a finding that was confirmed with contrast injection of the left SVC that rapidly filled the left heart chambers and subsequently the aortic arch. To treat this anomaly, we accessed the left basilic vein under ultrasound guidance and inserted a 14F sheath into the left subclavian vein. A covered stent was then prepared at the back table with three Prolene 4-0 sutures that were wrapped around the middle portion of the graft to achieve a controlled area of stenosis after deployment. The stent graft was placed along the proximal innominate vein and the contiguous part of the left SVC. Coil embolization was then performed with coils that were positioned at the stenotic area of the covered stent. An immediate venogram demonstrated residual flow into the left SVC; however, a delayed venogram 2 weeks after the procedure showed occlusion of the left SVC and the development of collaterals to the right innominate vein that was draining to a normal right SVC. The patient remained marginally hypotensive after surgery, but he soon noted a substantial improvement in his symptoms. A repeat echocardiogram with intravenous saline injection confirmed the correction of the right to left shunt. Endovascular repair of persistent left SVC is feasible and safe and can be performed with minimal morbidity

All-optical 3D atomic loops generated with Bessel light fields

The propagation invariance of Bessel beams as well as their transversal structure are used to perform a comparative analysis of their effect on cold atoms for four different configurations and combinations thereof. We show that, even at temperatures for which the classical description of the atom center of mass motion is valid, the interchange of momentum, energy and orbital angular momentum between light and atoms yields efficient tools for all-optical trapping, transporting and, in general, manipulating the state of motion of cold atoms.Comment: 13 pages, 9 figure